The main challenge in pharyngoesophageal reconstruction is the restoration of swallow and speech functions. The aim of this paper is to review the reconstructive options and associated complications for patients with head and neck cancer. A literature review was performed for pharynoesophagus reconstruction after ablative surgery of head and neck cancer for studies published between January 1980 to July 2015 and listed in the PubMed database. Search queries were made using a combination of 'esophagus' and 'free flap', 'microsurgical', or 'free tissue transfer'. The search query resulted in 123 studies, of which 33 studies were full text publications that met inclusion criteria. Further review into the reference of these 33 studies resulted in 15 additional studies to be included. The pharyngoesophagus reconstruction should be individualized for each patient and clinical context. Fasciocutaneous free flap and pedicled flap are effective for partial phayngoesophageal defect. Fasciocutaneous free flap and jejunal free flap are effective for circumferential defect. Pedicled flaps remain a safe option in the context of high surgical risk patients, presence of fistula. Among free flaps, anterolateral thigh free flap and jejunal free flap were associated with superior outcomes, when compared with radial forearm free flap. Speech function is reported to be better for the fasciocutaneous free flap than for the jejunal free flap.

Low-temperature thermal burns can occur in patients who have undergone microsurgery for a hand reconstruction. This is believed to be related to a disruption of the thermoregulatory function of the skin and poor nerve regeneration, as well as more heat accumulation in the surgical area after microsurgery.

Objective: Excess remnant skin is retained for use in additional grafting in case of split-thickness skin graft (STSG) failure. We hypothesise that regrafting with remnant skin offers greater efficacy and advantages in wound healing and donor site appearance. Methods: Skin graft donor sites were assessed by comparing those regrafted with remnant skin with those treated with polyurethane foam dressing. Healing time, pain, patient satisfaction, itching sensation, skin stiffness and irregularity between regrafting and foam dressing were compared. The aesthetic satisfaction of donor site was evaluated by four board-certified plastic surgeons. The differences were tested statistically. Results: A total of 39 patients received a STSG due to skin or soft tissue wounds caused by burn, trauma and cancer reconstruction. The donor site healing time was shorter with remnant skin regrafting compared with foam dressing. There was no difference with respect to donor site pain between the two treatment groups. At two weeks after skin graft, patient satisfaction was higher in those treated with remnant skin than in those treated with foam dressing. Aesthetic assessment was improved after 12 weeks. Conclusion: Donor site dressing using remnant skin appears to improve wound healing and enhance the aesthetic outcome of donor sites.

Skin ulcerations on old scars such as post-burn scar contractures are often suspected to be skin cancer. A 68-year-old woman with a 2-year-old skin ulceration, 1 cm in diameter, on her right anterior thigh, was initially suspected to be have Marjolin's ulcer. The patient had burnt her legs and trunk 50 years ago and had undergone hip joint arthroplasty 10 years previously. We suspected Marjolin's ulcer and performed a biopsy for diagnosis in an outpatient clinic. However, the histopathology indicated chronic inflammation. As routine X-rays revealed linear calcifications of the subcutaneous layer of the anterior thigh, we removed the area of calcification, including the skin ulceration. The surgical wound healed without complication. While heterotopic ossification is usually found in muscle layers around large joints, or in muscle layers subjected to trauma or surgery, its cause is unclear. We report a rare case of skin ulceration caused by subcutaneous tissue heterotopic ossification, which was initially mistaken as skin cancer, and ultimately treated with surgical resection.

Background: In the fingertip injury, there are many reconstruction methods such as skin graft, local flap, regional flap, and free flap. These methods can be performed immediately after injury. But when reconstruction can not be performed immediately, the raw surface of the finger tip is very painful and disgusting. We tried to find new dressing method with good wound care and high patient satisfaction before the surgery. Methods: From March 2016 to June 2017, 15 patients who acquired a fingertip injury, but could not undergo emergency surgery, were enrolled. A polyurethane foam was fixed to their fingertip damaged area using 6-0 nylon. After one week the fixed foam was removed. From the next day after the foam fixation dressing, subjective pain was checked for one week at two-day intervals and recorded on a visual analog scale (VAS). The formation of granulation tissue and occurrence of infection were checked. Results: Patients' pain gradually decreased over time. Patients' VAS score was the largest at 7.13 on the next day after the foam fixation dressing, and decreased to 2.72 at one week when the foam was removed. All patients had granulomatous tissue and no infection. Patients were able to successfully perform the fingertip reconstruction with a planned method. Conclusion: When the patient with fingertip injury cannot be operated immediately, foam fixation dressing can be used before the planned elective surgery. This may help to reduce patient's pain and to obtain good surgical results.

Reconstruction method choice in recurrent head and neck cancer depends on surgical history, radiation therapy dosage, conditions of recipient vessels, and general patient condition. Furthermore, when defects are multiple or three dimensional in nature, reconstruction and flap choice aimed at rebuilding the functional structure of the head and neck are difficult. We experienced successful reconstruction of recurrent laryngeal cancer requiring reconstruction of esophageal and tracheostomy stroma defects using a chimeric two-skin anterolateral thigh flap with a single pedicle.

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